Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 7384-120 | WI |
NPI | 1003135039 |
---|---|
Provider Name | Dan Borchardt |
First Address | Waukesha, WI 53188-3632 |
Second Address | Waukesha, WI 53188-3632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2010 |
Last Update Date | 01/06/2010 |